Provider Demographics
NPI:1407068851
Name:JOULE N STEVENSON MD LLC
Entity Type:Organization
Organization Name:JOULE N STEVENSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOULE
Authorized Official - Middle Name:N
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-731-7844
Mailing Address - Street 1:12277 DE PAUL DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2516
Mailing Address - Country:US
Mailing Address - Phone:314-731-7844
Mailing Address - Fax:314-731-3296
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:SUITE 406
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-731-7844
Practice Address - Fax:314-731-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002019263261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO40798V56535OtherHEALTHCAREUSA
MO507561801Medicaid
MO165057OtherBLUECROSSBLUESHIELD
MO321634OtherHARMONY HEALTH PLAN
MO520762OtherHEALTHLINK
MO165057OtherBLUECROSSBLUESHIELD
MO507561801Medicaid